Oregon HIX-IT Strategies and Status -...
Transcript of Oregon HIX-IT Strategies and Status -...
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Oregon HIX-IT Strategies and Status
Oregon Health Insurance Exchange IT ProjectPresented at the Medicaid Enterprise Systems Conference
August 22, 2012
Oregon Health Insurance Exchange
Corporation 1
• Oregon's HIX‐IT project is within the Oregon Health Authority, the state's Medicaid agency
• Oregon’s integrated HIX‐IT vision is supported by collaboration across all relevant state bodies– Building an integrated eligibility and enrollment marketplace for both
Medicaid, CHIP and tax credit eligible (and those without assistance)– HIX‐IT is a collaboration by OHA, the Oregon Health Insurance
Exchange Corporation, the Department of Human Services, and the Oregon Insurance Division
– Oregon's legislature has been very supportive, even prior to ACA
Oregon HIX‐IT ProjectLocal Partnership and Support
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Oregon HIX‐IT ProjectImplementation Approach
• Oregon's Health Insurance Exchange Information Technology (HIX-IT) platform will become the system of record for all Medicaid And CHIP (MAC) eligibility
• One automated eligibility system for both Qualified Health Plans (QHPs) and MAC (MAGI in Phase I)
• Enrollment in MAC will be accomplished by integration with legacy MMIS and commercial carrier systems
• Oregon's HIX-IT project has a complementary human service modernization project implementing "horizontally" integrated HHS eligibility and case management
• The project teams use a shared service approach and are implementing on the same technology platform
Oregon HIX‐IT ProjectVision Of Shared Logic and Data
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Applicants for medical coverage (Medicaid, CHIP, tax credits and self-pay commercial) can use either:• Exchange Portal• DHS Portal (or field office)
• Exchange will let likely eligibles know how to access other social services and "flag" DHS workers if applicant indicates interest
• DHS will determine eligibility for all programs (in a phased approach) and refer commercial inquiries to Exchange and its partners for shopping assistance
Exchange DHS Professional
Using Commercial Off The Shelf Products
Oracle Solution Stack
Oregon HIX‐IT ProjectTechnology Strategy
• Less time to construct
• Easier to reuse • Better ability to evolve
• Hosted in Oracle’s Cloud
• Using HP ALM for Application Life Cycle Mgt.
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Leveraging DHS and HIX-IT Projects as Spring-board to Transform All Services
Goal is to migrate all core HHS services in phases over 5 years
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Leveraging DHS and HIX-IT Projects to Transform IT Enterprise
COTS tools will be used as enterprise technology platform
Oregon HIX‐IT ProjectCurrent Status
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2011 2012 2013 Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Inception
Requirements High Level Business Requirements & Process
Modeling
Architecture Architecture Strategy, Modeling & Governance
Infrastructure Hardware & Software
Setup
Elaboration Funct ional
Areas Preliminary
JADS60 day HIX Corp Requirements
JADs & Use Case Documentation
OPA OPA Rules Workshops
Interfaces Carr ier JADS
Construction Funct ional
Areas Functional Prototype
Monthly Iterative Builds ‐Lite Scope Full Capacity Builds
Interfaces CMS Test Interface Development: SI Vendor
OPA OPA Rules Development Iterative Testing Iteravite Unit Testing Iterative Unit, System & Integration Testing
Transition
Testing Functional, Performance & UAT Testing
Training Training & Business Transition
MTP Move to Production
Production Performance Management Measure
Performance Success Ops &
Maintenance Support & Emergency Bug Fix
• Oregon HIX‐IT Timeline
Oregon HIX‐IT ProjectHIX Impacts on Oregon's Medicaid
Transformation• Huge Business Change for State Workers
– Create and Implement New Policies and Processes• New system for Medicaid intake and eligibility determination• Define and enable self service processes
– Configure and Implement New Technologies• Exciting new capabilities, but one more big tool to use• Challenge to effectively re‐train workforce and adapt to new system's limitations & opportunities
– Collaborate with New Partners• Common platform for private and public health plans means some policy and operations areas are shared across insurance, health, human service, and HIX entities
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Oregon HIX‐IT ProjectHIX Impacts on Oregon's Medicaid
Transformation• Vastly improved capabilities for citizens
– Citizens will be empowered to independently browse, search, compare, and enroll in both public and private health plans in one experience
– Users will have advanced capabilities such as real‐time verifications, automated eligibility determinations, online plan query capabilities, and a client portal
– Online user interface will automatically guide citizens to appropriate plans and subsidies
– Medical eligibility determinations will be consistent– Single experience will help people to transition as they become
ineligible for public programs
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Oregon HIX‐IT ProjectHIX Impacts on Oregon's Medicaid
Transformation
• Relevant HIX Technology Features:– Flexible rules engine– Citizen Portal and Professional Worker Portals– Identity Proofing and Client Master– Online Verifications (Federal Hub, State and Commercial Systems)– HHS Legacy Integration (MMIS, Eligibility, Client, etc.)– Carrier and SERF Integration– Limited Case Management– Re‐Usable Technology Platform
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HIX and Public Benefit Areas have Profound Interdependencies but Different Perspectives
Lesson Learned: a System Built for One Area Will Profoundly Affect Service Delivery Systems in the Other Areas
• "Heterogeneous" families encompass multiple benefit areas• Changes in eligibility ("swirl") move individuals across benefit areas• Service delivery and support services often span multiple benefit areas
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Multiple agencies must work together to achieve the right balance of integrated experience versus specialization
HIX and Public Benefit Areas have Profound Interdependencies but Different Perspectives
Contact:
Rusell Hargrave, Senior Health and Human Service Technology Advisor
Oregon Health Authority and Human Services, Office of Information Services
Email: [email protected]
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Appendix - Re-Use
What Will Oregon Share?• Gate Artifacts:
– Project Charter; PMO Plans; Schedules; Strategies – Requirements Set : BRD, FRD, UI Mock ups, Process Diagrams, Use Cases, OPA
Rules, Policy Decisions
• Code Repository and Corresponding Technical, Functional, Architectural, and Design Documents
How Will Oregon Share?• CALT; SERVIS; CALLS: EI LC, Monthly CCIIO, other; Conference Participation; Direct
Collaboration and Partnering• Contact Tracey Humphreys, Manager State & Federal Collaboration and Reuse
Oregon HIX‐IT ProjectStrategy for Sharing With Other States
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Oregon HHS Technical Model
Business Rules
Eligibility
Benefits
Client / Case Mgt
Alerts and Notifications
HIX: Medical Eligibility, Enrollment
DHS & OHA Content Websites
DHS: All Benefits Eligibility, Enrollment
DHS & OHA: Customer Service
Citizen Portals Enterprise Business Services
Workflow
Content Mgt.
Finance
Mobility Services
SOA Integration Layer
SOA Integration Layer
Vital Statistics
HIE Services
Collaboration
Business Rules
Enterprise Technical Services
Workflow
Master Data Mgt.
Privacy & Security
Immunization
Licensing
Laboratory
Electronic Health Records
Business Services
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Oregon HHS Technical Model
Business Rules
Eligibility
Benefits
Client / Case Mgt
Alerts and Notifications
HIX: Medical Eligibility, Enrollment
DHS & OHA Content Websites
DHS: All Benefits Eligibility, Enrollment
DHS & OHA: Customer Service
Citizen Portals Enterprise Business Services
Workflow
Content Mgt.
Finance
Mobility Services
SOA Integration Layer
SOA Integration Layer
Vital Statistics
HIE Services
Collaboration
Business Rules
Enterprise Technical Services
Workflow
Master Data Mgt.
Privacy & Security
Immunization
Licensing
Laboratory
Electronic Health Records
Business Services
WebCenter Portal & Content Mgt.
Siebel Mobility Module
MS SharepointContent Mgt.
Oracle Policy Automation Oracle Business Rules Engine
Sieblel
Sieblel
Sieblel
Sieblel
WebCenter content mgt. and Document Capture
Oracle Master Data Mgt.
MS Sharepoint, Outlook, etc.
Oracle ID Mgt, DB Vault, Advance Security Option, Active Directory
SOA
People SoftOrchard LIMS
Custom
HP Wisconsin Transfer
Open Source & NetSmart
Enterprise Integration Mgt.
WebCenter; Siebel Partner Portal
Oracle SOA Suite
Oracle SOA Suite